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PaperclipPerfector  1d ago (text post)   471 thread views

Wellness Wednesday for May 6, 2026

The Wednesday Wellness threads are meant to encourage users to ask for and provide advice and motivation to improve their lives. It isn't intended as a 'containment thread' and any content which could go here could instead be posted in its own thread. You could post:

  • Requests for advice and / or encouragement. On basically any topic and for any scale of problem.

  • Updates to let us know how you are doing. This provides valuable feedback on past advice / encouragement and will hopefully make people feel a little more motivated to follow through. If you want to be reminded to post your update, see the post titled 'update reminders', below.

  • Advice. This can be in response to a request for advice or just something that you think could be generally useful for many people here.

  • Encouragement. Probably best directed at specific users, but if you feel like just encouraging people in general I don't think anyone is going to object. I don't think I really need to say this, but just to be clear; encouragement should have a generally positive tone and not shame people (if people feel that shame might be an effective tool for motivating people, please discuss this so we can form a group consensus on how to use it rather than just trying it).

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What's the general rule for going to the doctor for a shoulder injury vs waiting to see it it'll heal? Are there any "shut up and go to the doctor" signs? I deal with so much chronic pain that I'm not sure what a reasonable person would do in my shoes.

I think usually, “if it still hurts in a couple of days, or if you can’t move it properly (not because it’s stiff)”.

Maybe try going to a physio before going to a doctor? Doctor will probably just tell you to go to a physio anyway.

That's a good idea. Thanks.

Check your state laws - doctor cartels have made it illegal to access PTs indefinitely without a doctor's stamp of approval in many states.

As per your link the restrictions include things like:

"A therapist who has more than one year of experience supervises any therapists licensed for less than one year."

And:

"The therapist thinks the care is within his or her scope. If a therapist thinks the care is outside of his or her scope, he or she must refer the patient to an appropriate healthcare provider."

How are these unreasonable?

Insurance is more likely to prove a barrier.

I knew I'd summon you with this comment. You've quite simply cherry picked some reasonable sounding lines and neglected to mention the other conditions.

For example:

"A therapist who has more than one year of experience supervises any therapists licensed for less than one year."

Wow, very reasonable, thank you AMA. That's Minnesota. What other restrictions do they have?

Therapy does not continue beyond 90 days without a referral.

So I stand by what I said - in many states it is illegal to see a PT indefinitely without seeing a doctor.

Yup. If it's an old injury, and there are no glaringly obvious signs of ongoing inflammation/disease, physio would be the first port of call. I imagine it's easier to go to a physio and then a doctor if they so advise, instead of the other way around.

Yes this is always my plan - straight to PT. Obviously I have more information which makes things a bit easier for me.

In the U.S. you do need to ensure your insurance will allow this, but a local PT can usually help walk you through that.

So I'm studying for the MRCPsych again, and the standard resource everyone uses for this is called SPMM. SPMM costs money. If you pay extra money, you get mocks. If you feel desperate, you can pay even more money, for a "stats crash course,".

The MRCPsych Paper B is heavy on statistics. Most of my colleagues find this difficult because most of my colleagues went to medical school, where the stats curriculum is approximately "p < 0.05 means good." I find it less difficult, which is not the same thing as enjoyable.

The problem is that SPMM's stats teaching is bad. I read a passage, frown, screenshot it, send it to ChatGPT or Claude, and ChatGPT says "yeah, this is wrong." This has happened enough times that it has stopped being surprising and started being a sort of recurring bit. The remaining percentage of the time, the notes are oversimplified to a degree that would make an actual statistician put their head in their hands, which I'll grudgingly accept as the cost of doing exam prep.

Now, I present the question that broke me today.

There's a study, presumably real, looking at childhood trauma and hallucinations in adulthood. There's a graph. The y-axis is the probability that someone has childhood trauma somewhere in their history. The x-axis is "number of hallucinatory modalities," running from 0 through 5, because apparently the authors decided five was enough senses and shipped it. Sure, I guess we can skip proprioception, vestibular positioning, and the other minor crap.

The question: "The predictor that emerged as the statistically significant variable is most likely to be..."

I pick ratio variable.

Let's examine my reasoning. The variable is a count. Counts have a true zero, where zero modalities is a meaningful and non-arbitrary absence rather than an arbitrary point on some scale. The intervals between values are equal: going from 1 to 2 modalities is the same conceptual distance as going from 3 to 4. And the ratios mean things, in that a patient hallucinating across four modalities is doing so across literally twice as many modalities as someone hallucinating across two. This is the textbook definition of a ratio variable. Stevens 1946. Every introductory stats book ever written.

SPMM informs me that the correct answer is "ordinal." I wanted to die.

I tried to be charitable. Maybe SPMM is operating from some idiosyncratic but defensible framework I'm not seeing. Maybe there's a niche position that count variables with low cardinality should be treated as ordinal because of how they behave in small-sample inference. Maybe somebody, somewhere, has a real argument.

I went to ChatGPT and laid out my case. ChatGPT said my logic was textbook, my answer was correct, and SPMM was wrong, but I should still pick whatever SPMM said in the actual exam because the exam doesn't care about being right, it cares about agreeing with whoever wrote the answer key. This is very sound career advice and also makes me want to lie down on the floor.

I pushed back. I said no, I have standards, I want to know whether there is some technical sense in which SPMM could be right and I am wrong. ChatGPT politely declined to manufacture one. After some pushing, it concedes, and says that I should go with my original answer if this specific question comes up in the actual exam. I screamed internally, because screaming externally would wake my neighbours.

The really insulting part is the upsell.

SPMM, having taught me statistics with the precision and care of a man hammering a nail with a banana, also offers a paid crash course in statistics. I will let you guess how I feel about paying them additional money to clear up confusions they themselves introduced.

There are two hypotheses.

Hypothesis A: SPMM is teaching stats badly on purpose, so that you have to buy the crash course to fix what they broke. This is the version I want to be true, because at least it would mean someone, somewhere, is in charge.

Hypothesis B: at some point, an underpaid registrar was handed a brief that said "write 500 stats questions, here's £500, you have a weekend". They paid peanuts, and the monkey just offered me a banana.

Hypothesis B is overwhelmingly more likely. It is also worse, because at least under Hypothesis A there's a coherent villain. Under Hypothesis B there's just a pipeline of tired people producing slightly wrong content for other tired people, who then sit in their flats at midnight wondering whether they're losing their minds or whether the material is in fact wrong, and there is no one to be angry at, because everyone in the chain was doing their best with too little time and not enough money, and the result is diffuse ambient wrongness that lives in PDFs forever, gaslighting trainees into doubting whether ratios still mean what they used to mean.

Anyway. Number of hallucinatory modalities is a ratio variable. It will continue to be a ratio variable on the day of the exam, and if it doesn't, the number of homicide victims in a future study will remain a ratio variable.

Edit:

The study is "Association between childhood trauma and multimodal early-onset hallucinations" in the BJPsych. The authors ran a hierarchical binomial logistic regression with childhood trauma as the binary outcome and number of hallucinatory modalities as a numeric predictor, reporting OR = 2.24 (95% CI 1.16 to 4.33) per additional modality. You can't meaningfully report a per-unit OR for an ordinal predictor. Reporting that OR is exactly what you do for a count variable on a ratio scale. The original authors treated it as ratio. SPMM has marked me wrong for agreeing with the people who wrote the study.

My usual recommendation for this kind of thing is to look for stuff you can pirate that US grads are using. Most US speciality boards have at least on killer app or test prep book. Easy to nab on Libgen or whatever.

Obviously might end up with different areas of focus but overall should get the job done?

How much does it matter? I mean, obviously it matters for passing the exam, but how much a practicing psychiatrist encounters a situation where they need to know statistics on this level and properly set up variables, unless they do academic research? Or, putting it in another way, if I learned psychiatrists are being taught and examined on wrong statistics, how scared should I be?

Not at all. You can spend your entire career as a psychiatrist without ever having to worry about whether you need to use ANOVA instead of MANOVA. I dare say most psychiatrists don't need to know any of this, I've never seen a senior of mine sit down and calculate PPVs or positive LRs while working with a real clinical case. If they ever knew, they've probably forgotten, and it doesn't seem to hurt them.

In theory, this information might come in handy if we need to do critical appraisals of a new paper or engage in research. That's the theory anyway, the practical aspects of it were already iffy, and these days? Everyone is going to check ChatGPT. There are zero clinical scenarios involving a real patient where this specific question matters.

Or, putting it in another way, if I learned psychiatrists are being taught and examined on wrong statistics, how scared should I be?

Don't lose sleep over it. That's my job. I'd rather be unemployed.

When ChatGPT says the SPMM is wrong, does it provide sources or a mathematical proof?

Yes. It's even something I order it to do in my user prompt, though it's pretty good about doing it my default.

I tell people to always ask for citations or double check the work when doing anything mission-critical with LLMs, and my professional trajectory counts. I usually ask both ChatGPT and Claude at the same time, to reduce the risk of error/hallucination being correlated, and if they disagree, I dig into it (assuming I haven't reviewed their sources and confirmed things to my own satisfaction). Of course, for less important topics, I don't go that far.

Here, SPMM is remarkably wrong. They're so wrong that they disagree with the original authors of the paper they've used for the question. In fact, every single fucking time I've asked, it's SPMM that's wrong and the LLMs correct (when they do disagree, my bullshit detector isn't perfect either).

Last week, I bought fried chicken from an M&S nestled inside my hospital, before heating it in a microwave and then joining the other doctors for lunch. Thought it was pretty solid, and this week, I nipped in to see if I could get another helping.

I found the same dish, read the label more closely and was... less than happy to discover that it said "cook before consumption" on the front, alongside "guidance for handling raw meat". The rear only confirmed my mounting horror. I dare say I felt outright queasy. Oh well, ignorance was bliss, and it's been long enough that if I was going to get salmonella, I'd know by now. I'd rather be a victim of deceptive advertising than food poisoning.

("Southern Fried Chicken", and you expect me to think it hasn't been fried already? Fuck.)

You should be able to tell the difference between raw and fried chicken. Raw chicken in dark meat is stringy and unchewable. You can just go to any grocery and buy a chicken thigh or drumstick and just feel it with your fingers. Cooking softens dark meat chicken considerably. In fact, while chicken is safe at 165F, cooking dark meat to 185F is preferable to make it softer.

Breast meat is a different story. Breast meat is not that stringy even when raw, it could be possibly hard to tell if you got very high quality, fresh chicken breasts and added strong seasoning. Cooking breast meat toughens it up a lot past a certain point. If you normally enjoy tender chicken breasts, it they were slightly raw you might just think they were especially tender. I prefer sous viding chicken breasts to a barely safe temp to get that raw-like tender juiciness and moisture.

Not sure how the labeling differs in other countries but in the U.S. plenty of frozen food still says you need to cook it to 165F for safety even though it's definitely not raw. I feel like it's more likely that it's an ass-covering situation than that the fried chicken was raw. Like, the breading wouldn't even be proper breading if it hadn't been cooked. It would taste and look like raw flour paste.

If it didn't look raw when you ate it, it must've been cooked by the microwaves.

It's a bit late to be praying that that's the case, but I'm not going to risk it again.

Can you eat raw chicken without noticing it? My experience with my own culinary experiments shows undercooked chicken has completely different taste and texture than a properly cooked one. Not sure about the pathogen risks but if you didn't notice I suspect it was not raw.

I'm not sure, it didn't taste raw at the time, though I can't that I've eaten raw chicken on purpose to take notes. I threw it in a microwave at maximum heat for 3 minutes before consumption, it came out hot, and didn't taste awful. That's the main reason I even came back looking for it.

I didn't taste raw chicken, but I tasted undercooked one (I did it to myself, have to admit) and it was rubbery and unpleasant. Generally it's not good idea at all to eat something like that, of course, but nothing bad happened to me, even though I started to check it more thoroughly on rare occasions I cook chicken (usually my wife does it and she knows how to do it right).

Apparently you can cook a single chicken breast in the microwave on high in 4-5 minutes so it might not have been that undercooked.

Threw out my back last week. The squat racks were all occupied, so instead of doing RDLs I did some back extensions on the Roman chair. I have no idea what I did wrong, I held just a single plate and the following evening my lower back seized up and I spent the next few days unable to sit down or bend over without pain.

Sorry to hear my man. Backs can be finicky. Hope it feels better soon.

It's better already. I first did something to my back back in 2020 in a Covid-induced coughing fit. Took a lot of time to fix it until I found a good neurologist with a YouTube channel. His main message was, "if you break your arm, do you immediately start trying to bend it again to make it less resistant to fractures? Of course not? So why do you think you should treat your back pain by constant stretches and twists and stuff? Leave it the fuck alone, let it heal! Go fix everything else around it! Fix your thoracic spine, fix your glute activation, fix your anterior chain!"

I did all that and realized that deadlifts and RDLs don't actually hurt my back. Can't say that about the girl that was doing deadlifts like a shitting dog, with her PT watching her like it was normal.

  1. Work. Job interview went well, although I'm not sure the start date is going to line up how I hope. Otherwise, wrapping up the resubmission for second first author paper (some drama there), and plugging away on my final paper.
  2. Fitness: Started running again, and going to start Norwegian singles/doubles next week.
  3. Intellectual Stuff: Plugging away at After Virtue. Discussed the Pacific War trilogy with my friend Dylan last night which was also very fruitful. Meditating consistently at least once a day now.
  4. Finances: Third roommate is still not locked down. Spending last month was only 2.6k, which led me to have an almost 30% savings rate!
  5. Dating. Nothing to report.
  6. Tarot. No session this week
  7. Socializing: Spanish happy hour and watching the Kinetic Sculpture race
  8. Screen time: 1 hour phone! Now do my PC haha.
  9. Mental health: feeling excited

How goes it @FtttG, @self_made_human @bird_crombie @falling-star @Tollund_Man4 ?

Back home from the accelerator in SF. Still partially burnt out but recovering. Weighed myself when I got home, only regressed 153 lbs -> 148, not as bad as I expected. Trying to put the weight back on with heavy use of fruit smoothies and protein powder, eating mad bowls of pork and rice.

Work demands haven't really relaxed. Early success means we have patients (generating operational tasks), but not money to actually hire more staff. So I've become an insurance biller on top of a fullstack engineer. Been telling myself I want unreasonable things so I'll have to work unreasonably hard to get them. It's hard though, pushing all the time and not having time to recover or experience normal life.

I had a girl that was at least receptive to me that I was really into. We never got to meet a second time 'cause I went to SF right after we met. I missed a chance to run into her at a rave recently because I was working. I got her on instagram and I get the live reminders in my feed that she's still around. Not sure if that's healthy or helpful.

@thejdizzler I remember you mentioned a while back coming into a good bit of money. Did you end up buying property or otherwise improving your life with it?

It's sitting in my Fidelity account still as a combination of index funds, CDs, and cash. I'm going to buy a house with it once I get a job post PhD.

Spending last month was only 2.6k, which led me to have an almost 30% savings rate!

Congratulations on that. I wonder if there's enough interest in personal finance, investing, and what-have-you for a "Money Monday" thread.

I'd be interested!

Why not just this one? Financial wellness is real wellness.

Shareholder Saturday? Or Speculator.

The choice of day should perhaps be strategic. The weekend is a great time for screening for stocks to buy at the start of the next week.

That's a good point.

Be the change you want to see in the world. I'll be watching it with interest (pun completely unintended, I only noticed it after the fact).

"Fiscal Friday" has a better ring to it than "Money Monday" though, IMO.

Friday's already taken sadly.

Is there a rule saying we can't have two different threads on the same day?

I mean, there aren't that many threads which get posted. I think it's ok to have more than one weekly thread on a given day.

  • My upper back and shoulders felt stiff from Tuesday onwards last week, so I didn't feel up to going to the gym. Ended up having to do all three sessions back to back on Friday-Sunday. The most frustrating thing is that I was doing deadlifts on Saturday and felt absolutely fine during and afterwards, but when I woke up on Sunday morning I could feel that I'd aggravated my dodgy disc, yet again. I have no idea what I'm doing wrong, I genuinely thought I'd perfected my deadlift form. A quick Google suggests that I need to improve my core strength, so I'm planning to go to the gym this evening and do some core exercises (plank etc.). Any advice for strengthening my core would be greatly appreciated. Can deadlift 1.84x my bodyweight for 3 reps, squat 1.15x for 7 reps and bench press .87x for 6 reps.
  • Have not consumed any pornography since waking up on January 1st.
  • Planning to post my twelfth blog post of the year either today or tomorrow morning.

I'll give myself a pass mark, not because I physically went to the gym (I didn't), but because I've been doing non-zero amounts of exercise at home and bought a set of dumbbells (which I did use! I'm not using the mere act of purchase as an excuse).

The next few weeks are going to be hectic. I've got an important exam coming up, and while that's not entire incompatible with working out regularly, it makes it hard.

Keep the dumbbells by your computer. Work in a few reps when you pause to think or switch tracks.

Spending is $990.72 higher than it was at the same time last year. Almost all of this difference is due to the dental bills and home repair/maintenance bills that I've racked up this year.

I do have some additional non-standard spending on top of that:

  • I prepaid for my annual pest control bill that keeps my house from getting destroyed by carpenter bees, since the company offers a discount.
  • I took my brother and his girlfriend out for a belated birthday lunch.
  • I went out with my partner and got us some Mexican.

On the bright side, I negotiated a $10/month discount with my ISP. It's not much, but it's not nothing.

It's frustrating that I can't really get ahead compared to last year, but I'm also glad that I've been making the effort. I'd probably be cashflow negative for a few months already if I hadn't made this resolution.

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